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General NPI Number Information
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NPI Number | 1255458014
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Entity Type | Individual
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Provider Name | BRANDON M LUM MSPT
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Gender | Male
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4625 SAINT CROIX LN APT 1134 APT. 1134
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City | NAPLES
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State | FL
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Zip | 34109-3536
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Country | US
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Telephone | 617-780-6953
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 SE PETIT LN
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5424
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Country | US
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Telephone | 772-335-5828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22730
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License Number State | FL
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